Journal Article

Development and validation of a nomogram for predicting postoperative survival in patients with multifocal hepatocellular carcinoma

Li, Guangming, Zhang, Gongming, Liu, Bojun

2025

Overview

Background Hepatocellular carcinoma (HCC) is the fifth most common malignant tumor and the third leading cause of cancer-related death worldwide. Despite the significance of multifocality in HCC (M-HCC), most studies have predominantly treated it as a prognostic factor, lacking in-depth investigation into its prognostic implications. This retrospective study aims to integrate clinical and laboratory examinations to construct a predictive model that more accurately forecasts the prognosis of patients with M-HCC. This aims to guide personalized treatment strategies and improve overall survival rates. Methods We applied the Lasso and cross-validated Lasso (CV-Lasso) combined with Random Forest analysis to explore the prognostic factors influencing M-HCC. Simultaneously, we utilized the identified prognostic factors to construct a Nomogram. This Nomogram assigns scores based on the magnitude of the impact of each factor on prognosis, enabling the prediction of postoperative survival rates for patients. Subsequently, the model-derived risk scores categorized patients into low-risk and high-risk groups, and Kaplan–Meier curves were generated. Results The patients, who were enrolled, were divided into training and validation sets. Factors influencing the prognosis of M-HCC were identified through Lasso, cross-validated Lasso, and Random Forest analyses, revealing seven key factors: Age, Antiviral, Child–Pugh, Cirrhosis, White Blood Cell (WBC), Platelets (PLT), and Thrombin Time (TT). Nomograms were constructed based on these factors to predict 3-year, 5-year, and 8-year survival rates. ROC curves confirmed the predictive capability of various factors, with larger areas under the curve at 5 (AUC = 0.653) and 8 years (AUC = 0.733). Kaplan–Meier curves stratified patients into low-risk and high-risk groups, showing significantly higher survival times in the low-risk group (p < 0.0001). Conclusions Postoperative antiviral treatment for patients with M-HCC, aimed at enhancing immune function and protecting liver function, has been shown to extend patient survival. Simultaneously, factors such as Child–Pugh, age, and Cirrhosis in patients with M-HCC have been associated with a decrease in postoperative survival time.

• Publisher: Springer US,Springer Nature B.V,Springer
• Subject: Blood / Cancer Research / Cholangiocarcinoma / Cirrhosis / Hepatitis B / Hepatitis C / Hepatocellular carcinoma / Internal Medicine / Laboratories / Leukocytes / Liver cancer / Liver cirrhosis / Liver diseases / Liver resection / Liver transplants / Lymphocytes / Medical prognosis / Medicine / Medicine & Public Health / Metastasis / Molecular Medicine / Mortality / Multifocal hepatocellular carcinoma / Nomograms / Oncology / Overall Survival / Patients / Radiotherapy / Surgery / Surgical Oncology / Tumors